November 14, 2024 • 23 mins
In Episode 51 of the Pound of Cure Weight Loss Podcast, Dr. Matthew Weiner and dietitian Zoe Schroeder tackle listener questions on NAION vision, mocktail ideas, limited weight loss after a sleeve gastrectomy, and managing the “murky middle” phase after surgery. Here’s a quick recap of the insightful advice and tips offered in this Q&A episode.
Understanding NAION Vision Risks with GLP-1 Medications
The episode kicks off with a question about the connection between GLP-1 medications (like Ozempic and Wegovy) and NAION vision, a rare eye condition that can cause sudden vision loss. Dr. Weiner explains that NAION is often linked to low blood pressure, a risk that can increase with weight loss. He advises patients on GLP-1 medications to monitor for symptoms like dizziness upon standing, as these may indicate hypotension and increased NAION risk. Adjusting blood pressure medications may be necessary as weight drops.
Key Takeaway: If you’re taking GLP-1 medications and blood pressure medicine, monitor your blood pressure closely. Weight loss may require medication adjustments to lower the risk of hypotension and NAION.
Mocktails: A Fun, Alcohol-Free Way to Celebrate After Surgery
The next question dives into mocktails, a perfect option for those who want to celebrate without alcohol after gastric bypass surgery. Zoe shares ideas for tasty, sugar-free mocktails, like mixing sparkling water with hibiscus tea and adding frozen watermelon cubes for flavor. She also encourages listeners to use fancy glasses and creative garnishes to make the drink feel special.
Mocktail Idea: Hibiscus tea with sparkling water and frozen watermelon cubes makes a refreshing, celebratory drink that’s low in sugar and calories.
Key Takeaway: Mocktails can help you enjoy social occasions without alcohol. Use sugar-free ingredients and fun presentation to keep them bariatric-friendly and festive.
Limited Weight Loss After A Sleeve Gastrectomy
A listener who had a sleeve gastrectomy but lost less weight than expected wonders why their experience differs from others. Dr. Weiner explains that weight loss results vary widely, with some patients experiencing more dramatic changes than others. He emphasizes the importance of combining surgery with lifestyle changes and, if necessary, GLP-1 medications to amplify weight loss.
Key Takeaway: Every weight loss journey is unique, and surgery alone may not guarantee specific results. Combining surgery with lifestyle changes and, if needed, GLP-1 medications can enhance weight loss success.
Navigating the Murky Middle Phase of Weight Loss After Surgery
The episode concludes with advice on navigating the “murky middle” phase around six months after surgery. This stage involves adjusting to a slower weight loss rate and a returning appetite. Zoe suggests shifting from a protein-focused diet to one rich in vegetables, fruits, and nutrient-dense foods to avoid the “portion control trap,” where patients eat small portions of high-calorie foods, risking long-term regain.
Key Takeaway: Use the murky middle to build healthy habits with nutrient-dense foods, setting up a foundation for sustainable weight loss and maintenance.
Conclusion: Small Changes for Long-Term Success
In Episode 51, Dr. Weiner and Zoe underscore that bariatric surgery and GLP-1 medications are tools, not quick fixes. By making mindful adjustments and focusing on healthy eating, patients can set themselves up for long-term success.
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Zoe (00:00):
it's a whole heck of a lot easier to make lasting changes
to your habits when you'refeeling successful and you are
experiencing progress than it isto wait until you're at your
weight and you're in maintenanceto then okay, now, once I lose
all my weight, then I'm going tochange my eating habits.
Well, you're not gettingpositive reinforcement from
seeing you know those changes asmuch in your body.
(00:20):
So it's something we definitelywant to look out for and nip in
the bud if you find yourselfkind of falling down that trap.
Hello, and welcome back to thePound of Cure weight loss
podcast.
When a sleeve isn't enough.
Yes, today we're talking aboutour.
We're talking through thequestion and answers that we get
(00:43):
from our social media and ourwebsite.
So before we dig in, if youhave a burning question or you
have a question, be sure to dropus a line and ask your question
so you might be having yoursanswered on our next episode.
Dr. Weiner (00:55):
Yes, go to our website.
It's poundicureweightlosscomslash podcast and there's a form
you can drop a question in andwe'll be happy to answer it on
the next episode.
So why don't we hear from ourtrusty office manager, sierra,
what our first question is?
Sierra (01:11):
Our first comment comes from Clark Kent on our YouTube
short Will Ozympic Make you GoBlind?
I recommend that you watch Docswho Lift podcast, where they
interview Dr Bruger, who is anophthalmologist specialist.
He pointed out some veryimportant things for obesity
doctors to keep in mind.
The top reason for Nyon is lowblood pressure at night.
(01:33):
In other words, doctors need tomonitor closely for low blood
pressure.
As you lose weight, they likelyneed to adjust your blood
pressure medication.
In addition, the doctor mayrecommend that you take your
blood pressure medication in themorning instead of the evening
or at bedtime.
As always, never change yourmedical treatment without
consulting a doctor.
Dr. Weiner (01:53):
So this question is one of the reasons why I love
doing this podcast, becausereally there's so much insight.
This is someone who's clearlydoing their research.
So first let's review what NIONis N-A-I-O-N.
This is something we talkedabout in a past episode.
There have been a few casereports and an extremely poorly
(02:15):
done study that onlydemonstrated correlation did not
come anywhere even close toproving causation was a highly
selective study in a small groupof people that did show that
there was an increased rate ofvision loss or blindness in
people who were taking Ozempic,and the disease is NION, which
(02:38):
stands for non-arteriticanterior ischemic optic
neuropathy.
I had to look that up.
I'm not an ophthalmologist andcertainly not an expert at this,
but their comment abouthypotension or low blood
pressure causing this there'ssomething there.
There's a lot of good sciencebehind that.
(03:00):
These medications Ozempic,monjaro, zepbam, wegovi, all of
them can cause a decrease inyour blood pressure.
They can cause it eitherdirectly or through weight loss.
Just entering this weight lossphase can bring your blood
pressure down.
We see this after bariatricsurgery.
If someone's on three bloodpressure medications and I do
(03:21):
bariatric surgery before they'veeven lost a pound, I stop at
least one of those medications,sometimes two, because I know
their blood pressure is going todrop very rapidly in those
first few weeks after surgery,because that weight loss phase,
the act of losing weight, iswhat causes the blood pressure
to drop.
And so we're putting patientson these GLP-1 meds and maybe
(03:44):
not adjusting their high bloodpressure meds, and so the blood
pressure is dropping.
And again, I'm not anophthalmologist.
I think this is a very goodpoint.
If this is what's causing theION, I could believe it.
But again, I would certainlyleave this up to someone who
studies this disease on aregular basis, on a regular
(04:05):
basis.
But I think the point is verywell taken, which is that if you
are on one of these medicationsand you also take blood
pressure pills, that you shouldpay very close attention to your
blood pressure.
The classic symptom of beingoverdosed on your blood pressure
medicine is what's calledorthostatic hypotension, which
means you stand up and you feeldizzy or faint for a few seconds
and you can actually pass outfrom this and that can be quite
dangerous.
It's the fall, that's thedangerous part.
(04:26):
You're not going to faint andgo into cardiac arrest or
anything like that, it's justyou're going to fall and hit
yourself, hit your head orsomething.
If you are standing up andyou're starting to take one of
these medications, or you've hadbariatric surgery and you're
standing up and you're feelingdizzy or faint, that's certainly
something you should be callingand talking to your doctor
(04:47):
about and potentially holdingoff on your blood pressure
medication and adjusting thatrelatively quickly.
That's a very good point.
Great question.
Zoe (04:55):
Yeah, well, and also it leads me to think, you know,
hopefully there's more studiesthat might be a little bit more
robust to show potentially thecausation rather than the slight
correlation.
Dr. Weiner (05:07):
Yeah, this article came out probably two months ago
and there really hasn't been alot of uptake on it.
I don't see anybody kind oftalking too much about it.
There's not a lot of concernabout it.
Everybody kind of recognizeshey, that's kind of an
interesting point.
But we certainly would need alot more data before we would
change our prescribing habitsbecause of all the good things
(05:29):
that these medications can do.
So all right, sarah, what's ournext question?
Sierra (05:34):
Okay, next question comes from our podcast episode
how a Gastric Bypass Could Ruinyour Life.
This question is from Pearl.
What do you think aboutmocktails?
Zoe (05:46):
in your life.
This question is from Pearlwhat do you think about
mocktails?
Okay, I love this questionbecause I love making mocktails
and I love drinking them out offancy glasses.
That's the key is drinking themout of a wine glass or a fancy
glass because it makes it feelmore special.
But we have to be careful withmocktails, especially if you're
ordering them out at arestaurant, because they can be
very sugary, just like cocktails, right.
And so a couple of my favoritecombinations for mocktails take
(06:11):
sparkling water, right, like aLa Croix or whatever, and
pairing it with either muddledfruit or some sort of
fruit-based herbal tea.
And so a combination that I'vereally enjoyed is Target has
this really delicious hibiscusraspberry tea, and the key is
because it's so vibrant in color, it's gorgeous and it's
(06:33):
naturally sweet.
Putting a little bit of thatwith some sparkling water and
like a lime wedge or somethinglike that in a wine glass, and
you've got a perfect, refreshing, hydrating mocktail.
Yeah, something else that I've Ican't remember if I've talked
about this yet.
However, what I love to do thissummer was actually freeze
(06:55):
watermelon cubes, and thenthey're.
So here's what you do you sliceup your watermelon into cubes,
but you can't plop them all intoa bag and then freeze them,
because they'll all clumptogether and freeze together,
right?
So putting them on a cookiesheet first, individually freeze
them, because they'll all clumptogether and freeze together,
right?
So putting them on a cookiesheet first, individually freeze
them, and then, once they'refrozen, then you put them in the
gallon size Ziploc bag and takea couple out, put them in your
(07:19):
glass, pour some water orsparkling water over the top,
and not only does it keep thedrink cold, but that watermelon
juice starts to flavor the wateras well, and I found that
really nice yeah.
Dr. Weiner (07:32):
I think we've associated alcohol with
celebration and there's a lot ofpeople out there who are like
they have one drink, oh, I'lljust have it.
Yeah, no, I'll have a drink,I'm going to celebrate.
And the truth is that one drinkof alcohol probably does very,
very little to kind of causethem to feel drunk and really
doesn't change the way they feelvery much.
(07:55):
It's just not a ton of alcohol,but yet they all have a drink,
because that's what you do whenyou celebrate.
But it really is that act ofhaving that kind of special
drink.
You know, with that watermelonice cube or the lime wedge on
the side of the glass or thefancy glass or the fancy ice
cubes, you can buy the squareblock or the special molds.
(08:15):
And I think that's a reallyinteresting point is that
there's other ways to kind ofmake a drink special Elevate,
elevate, I love that word.
There's other ways to elevate adrink besides adding alcohol.
Zoe (08:27):
Absolutely, and also this is something that I talk with
people about all the time Ifthey're really struggling to get
their hydration in or theydon't like water by itself is
how can we jazz it up, make it alittle bit more exciting, make
it a little bit more special?
And so definitely love thedifferent cocktail varieties or,
I'm sorry, mocktail varieties.
Dr. Weiner (08:46):
Yes, I would share your, your passion for hibiscus,
tea.
It really is delicious.
Yeah, it's is delicious.
Yeah, it's kind of that perfectherbal, fresh, little citrus.
Absolutely All right, sierra.
How about our next question?
Sierra (09:00):
Next question was on our YouTube video, small Weight
Loss After Sleeve, bella Donnaasks I had my surgery almost two
years ago and it almostliterally did nothing.
I lost 15 pounds on my own withthe liquid diet and only 20
(09:20):
pounds after surgery.
I have a lot of friends andfamily that have had the same
surgery and were at least twicemy size and are all now very
thin.
But I had a very differentexperience.
First off, I was in a lot ofpain after surgery and I had
been told by almost everyone.
First off, I was in a lot ofpain after surgery and I had
been told by almost everyonethat they didn't have any pain
afterwards, except for the firstcouple of days.
I experienced no nausea orvomiting, no change to my
(09:41):
appetite or cravings, noproblems with food going down.
It just went a little slowerthe first couple weeks Nothing.
The only thing that happenedwas I had to have my gallbladder
removed shortly after mysurgery.
Literally nothing changed.
I even went in for a follow-upand if it weren't for the pain I
felt after surgery and thescars, I would have thought that
(10:01):
they never did the surgery.
Dr. Weiner (10:04):
So this is complicated.
So I think, first of all, a lotof people look at that pre-op
weight loss on the fasting dietand they discount it like, oh,
the surgery didn't do that, Idid that before surgery.
But the truth is they did itthrough a very low calorie diet.
That's what the pre-op diet is,and we know that.
What happens if you go on avery low calorie diet, what
(10:26):
happens afterward?
You lose a lot of weight.
You lose a lot of weight andthen, if you don't have surgery
or do anything else, you gain itall back right.
So that way, even though youlook at it and say, oh, I'd lost
it before the sleeve, you wouldhave gained it all back.
So if you still have maintainedthat weight loss that's I that
weight loss belongs to thesleeve it all's bundled up
(10:46):
together exactly so.
So this person lost 15 poundsbefore and then lost about 20
pounds after sleep 35 pounds.
We don't know what theirstarting weight is.
That's certainly.
I don't think.
There's not really anybodygoing into the surgery saying I
want to lose 35 pounds, right?
Most people have 50, 60, 70pounds and that's what they're
hoping for.
We've talked about this overand over again.
(11:07):
With the sleeve, there's a lotof variability.
There are some people who don'tlose a ton of weight and there
are other people who lose crazyweight, and that's one of the
things that I find sometimesfrustrating.
The advent of GLP-1s has addedthat extra buffer where we can
add the GLP-1 in and now we cantake that kind of modest weight
(11:28):
loss and augment it.
But to me, this is a patientwho is not very happy with their
results, and I get it.
They didn't lose as much asthey wanted.
But that's why the pre-opeducation is important and also
why the post-op care isimportant, like the meeting with
(11:49):
the dietician on a regularbasis to make sure the nutrition
is optimized, staying involvedin your bariatric program.
If there's an option forgetting you started on GLP-1s,
you take that option.
This is a lifelong struggle.
This is not a one and donetreatment, and so the idea that
you're just going to have asleeve and then go on with your
(12:11):
life and lose tons of weight, itmight happen.
It also might not, and there'slots and lots of people out
there on both sides of thatequation.
Lots of people have been supersuccessful and super happy with
their sleeve, lots of people whoare not so happy with their
sleeve, and that's what I thinkseparates the you know, an
average bariatric program from agreat one.
(12:33):
A great bariatric program isgoing to have in place for you
the dietician support, the GLP-1medications, all of the other
things.
You need to take that halfthose patients who don't have a
great result from their sleeveand help them get that good
result.
Amplify it up as much aspossible.
What are you going to do withthis patient if they're in your
nutrition group?
Zoe (12:52):
So, of course, we would want to make sure that we're
optimizing their nutrition.
Are we really taking fulladvantage of the tool?
Because the sleeve is still atool, whether they lost 20
pounds, 35 pounds after or not,it's still a powerful tool that,
when combined with thelifestyle modifications, we can
(13:14):
potentially amplify it further.
Right?
So I would see, did it say howlong, um, how long ago they had
their, their sleeve?
I?
Dr. Weiner (13:22):
don't know if they specify that.
Zoe (13:24):
So, depending on how long after those hunger cues coming
back, maybe the volume of foodtolerated is increasing again.
This patient could potentiallyreally benefit from doing the
metabolic reset diet or, like Iwas talking with somebody on a
one-on-one today, a modifiedmetabolic reset diet.
She had a sleeve about a yearand a half ago and we were
(13:47):
talking through how to modifythe metabolic reset diet so that
she could still follow theprinciples but maybe not push
the volume quite as high.
So that would be something Iwould also really want to be
interested in.
How can we tweak the movement?
Do those movement sprinklesReally?
Just digging into all of thoseother lifestyle factors that can
(14:08):
, like I said, amplify theeffects of the tool?
Dr. Weiner (14:11):
Right, yeah, and I think that's this to me.
This, this comment, reallyshows that it's not just having
the surgery and then getting theresult.
Zoe (14:20):
Not the easy way out.
It's not the quick fix, yeah.
Dr. Weiner (14:23):
This is part of a comprehensive plan and to me, I
think that's what's missing isthat we haven't put that
comprehensive plan in place.
There's some people out therewho kind of get lucky and it
just all falls into place andit's a one and done surgery.
We see that certainly more witha gastric bypass than a sleeve,
but we see it with a sleeve too.
I think this person is alsocomparing themselves to other
(14:45):
people and that generally isn'tgoing to help much.
Yeah, your journey is yourjourney.
Recipe for frustration, yeah,and so I think you have to, kind
of, instead of looking at whatother people's experience has
been and saying, why didn't Iget that same experience, you
have to look at what yourexperience is and see how you
can make your life better.
Yeah, because that's your onlyrealistic option right now.
Right.
Zoe (15:03):
Yeah, you can't control the outcomes of other people, but
you know, even if theirbariatric center didn't, doesn't
have the nutritional support.
Of course, our nutritionprogram is open to anyone in the
country, so if you're in asimilar situation and you're
struggling post-op, um, or youknow you're on a GLP-1 or
(15:24):
whatever, I would be happy tohave you in our online Zooms and
really amplifying that toolthrough your nutrition changes.
Dr. Weiner (15:32):
And we do have a platinum program.
So we'll see people from allover the country through our
platinum program and I'll meetwith them and we'll try to
figure out what happened andwhat we can do to rescue it.
And a lot of times we can getpeople back on track and get
them the weight loss that they'dhoped for originally.
It might not be as easy as theythought it was going to be, but
it's possible.
Zoe (15:53):
It's a good option to explore.
Dr. Weiner (15:54):
All right.
What's our last question,Sierra?
Sierra (15:57):
Okay.
Last one is from our YouTube,episode 38, a Dose of Dilemma.
Nicole Chip asks I started thePound of Cure diet six months
before my gastric bypass.
Eating a pound or more ofveggies was no problem back then
.
In the first few months aftersurgery, I understood that my
nutrition priorities would bedifferent for a while, as I
(16:19):
recovered and focused on proteinand figuring out which foods I
could tolerate.
But now, at six months out, myappetite is starting to return a
little bit, and so I know I'mnearing the stage you speak
about of moving away fromprotein first to produce first.
But so many bariatric resourceseither assume you are in the
first six weeks or that you areseveral years out from surgery
(16:41):
and battling regain.
I would love to hear youradvice for navigating the murky
middle when you're still losingweight, but at a slower pace,
and it's not quite the earlyhoneymoon phase anymore, but not
quite the new normal either.
How do we get from point A topoint Z with as few bumps in the
road as possible?
Dr. Weiner (16:59):
Zoe, what do you think about the murky middle?
Zoe (17:02):
I think the murky middle can be murky but it's also can
be a really great opportunity.
Yeah, to almost like practicefor maintenance.
Right, because maybe that murkymiddle is when they can start
eating a bit more.
Their hunger maybe starts tocome back and it's like, okay,
I've been trained or instilledto prioritize protein and that
(17:26):
might feel like a littlelackluster at this time, right,
and so as I like to describe it?
Sure, yes, we still want toprioritize protein, but ideally
through whole food protein andweaning off of those protein
shakes so much.
But the key is really adding inthat extra volume and filling
in the gaps.
I always like to say fill inthe gaps, anything else that you
(17:49):
can eat, with vegetables, withfruit, so that you are still
helping with your weight loss,but you're getting that fiber,
you're getting that volume, soyou feel full and satisfied and
kind of helping that yourselfthrough that honeymoon period a
bit more, maybe pushing througha plateau or getting that last
(18:10):
bit of weight loss during yourmurky middle honeymoon period,
but utilizing that time.
It's not that we want to goback and reset the pouch, go
back to only shakes.
That's always going to backfire, from my experience.
Dr. Weiner (18:23):
Yeah, no, I agree with you.
I think the way you put it isexactly right.
In those first few months it'slike I can barely get in enough.
I just got to get in what I canget in so I can survive.
And you're worried about yournutritional state and your
health.
And with being conscientiousand thoughtful, we get everybody
through it and it tends to befairly comfortable, but it is
(18:43):
some work.
But then all of a sudden youget into what we call the murky
middle A lot of people call itthe honeymoon phase and you can
suddenly eat a little bit more.
And you're right, what you do?
You put in the vegetables andyou can eat a little bit more
after that more vegetables, morefruit, more nuts and seeds,
beans, and so it's going to be agradual process and understand
(19:05):
that that's the journey.
Zoe (19:07):
And that's where also it can fall.
People can fall into theportion control trap.
Dr. Weiner (19:12):
Absolutely.
Zoe (19:13):
You know that murky middle can be a dangerous slippery
slope, right If you're notviewing it from the lens of.
This is my opportunity tocapitalize on the honeymoon
period with my tool and toinstill these eating habits that
(19:35):
I know are going to help memaintain the weight loss longer
term.
But that portion control trapoof, that is a dangerous one.
Talk a little bit more aboutthe portion control trap.
So the portion control trap issomething that I see some people
struggle with.
Dr. Weiner (19:46):
It's out there for sure.
Zoe (19:48):
Especially, I'd say, people who maybe come to us in the
platinum program experiencingsome weight regain after their
sleeve let's say likely due tofalling into that portion
control trap, which is utilizingthe portion control aspect, the
volume restriction aspect ofthe surgery, to just eat less
(20:12):
and not change how they'reeating.
So it might be, oh, I'm justgoing to have half of the slice
of pizza and then that turnsinto a slice and then you know
pretty soon eating the sameamount as before.
But what's really dangerousabout it is because, especially
during that honeymoon period,when your hormones are working
with you as well as the portioncontrol aspect, you're getting
(20:35):
that positive reinforcement fornegative behavior.
Dr. Weiner (20:39):
No consequences to eating poorly in the murky
middle Right there will be downthe road, exactly yeah.
Zoe (20:44):
And you know it's a whole heck of a lot easier to make
lasting changes to your habitswhen you're feeling successful
and you are experiencingprogress than it is to wait
until you're at your weight andyou're in maintenance to then
okay, now I'm once, I lose allmy weight, then I'm going to
change my eating habits.
Well, you're not gettingpositive reinforcement from
(21:05):
seeing you know those changes asmuch in your body.
So it's something we definitelywant to look out for and nip in
the bud if you find yourselfkind of falling down that trap.
Dr. Weiner (21:14):
Yeah, we know that at three months, you can't eat
nearly as much as you're goingto be able to in a year, and at
two years it's going to be evenmore.
We know there's going to bethis progression.
You will be able to eat moreand more and more as you move
through the murky middle, and sothe question is what are you
going to fill it with?
Because you are going to fillit, you're going to eat more,
(21:36):
and are you going to fill itwith a bigger piece of pizza, or
are you going to fill it withmore fruits, veggies, nuts,
seeds and beans?
Zoe (21:47):
If you watching this podcast, I think you know the
answer to that one and the other.
The last little note I wantedto say on that is don't expect
yourself or force yourself toeat that same small amount that
you were eating at three monthsout.
When you're a year out I talkto people about that too it's
like, oh well, I was only eatingthis small amount, I should be
eating that same amount.
And I was like, well, no,because if you're depriving your
(22:08):
body of what it of, that, thatfuel, and you're just kind of
ignoring that hunger, it's goingto catch up, it's going to
backfire, and then that, could,you know, lead to going down the
wrong path.
Dr. Weiner (22:22):
Yeah, all right.
Well, thank you for watching orlistening.
We're on social media TikTok,instagram, youtube.
A pound of cure, a pound ofcure, and please reach out to us
, drop us questions for our nextQ&A session.
We'd love to hear from youwhether things are going well
for you, whether you'restruggling.
(22:42):
Tell us how you're doing.
Zoe (22:44):
Yeah.
Dr. Weiner (22:45):
See you next time.
it's a whole heck of a lot easier to make lasting changes
to your habits when you'refeeling successful and you are
experiencing progress than it isto wait until you're at your
weight and you're in maintenanceto then okay, now, once I lose
all my weight, then I'm going tochange my eating habits.
Well, you're not gettingpositive reinforcement from
seeing you know those changes asmuch in your body.
(00:20):
So it's something we definitelywant to look out for and nip in
the bud if you find yourselfkind of falling down that trap.
Hello, and welcome back to thePound of Cure weight loss
podcast.
When a sleeve isn't enough.
Yes, today we're talking aboutour.
We're talking through thequestion and answers that we get
(00:43):
from our social media and ourwebsite.
So before we dig in, if youhave a burning question or you
have a question, be sure to dropus a line and ask your question
so you might be having yoursanswered on our next episode.
Dr. Weiner (00:55):
Yes, go to our website.
It's poundicureweightlosscomslash podcast and there's a form
you can drop a question in andwe'll be happy to answer it on
the next episode.
So why don't we hear from ourtrusty office manager, sierra,
what our first question is?
Sierra (01:11):
Our first comment comes from Clark Kent on our YouTube
short Will Ozympic Make you GoBlind?
I recommend that you watch Docswho Lift podcast, where they
interview Dr Bruger, who is anophthalmologist specialist.
He pointed out some veryimportant things for obesity
doctors to keep in mind.
The top reason for Nyon is lowblood pressure at night.
(01:33):
In other words, doctors need tomonitor closely for low blood
pressure.
As you lose weight, they likelyneed to adjust your blood
pressure medication.
In addition, the doctor mayrecommend that you take your
blood pressure medication in themorning instead of the evening
or at bedtime.
As always, never change yourmedical treatment without
consulting a doctor.
Dr. Weiner (01:53):
So this question is one of the reasons why I love
doing this podcast, becausereally there's so much insight.
This is someone who's clearlydoing their research.
So first let's review what NIONis N-A-I-O-N.
This is something we talkedabout in a past episode.
There have been a few casereports and an extremely poorly
(02:15):
done study that onlydemonstrated correlation did not
come anywhere even close toproving causation was a highly
selective study in a small groupof people that did show that
there was an increased rate ofvision loss or blindness in
people who were taking Ozempic,and the disease is NION, which
(02:38):
stands for non-arteriticanterior ischemic optic
neuropathy.
I had to look that up.
I'm not an ophthalmologist andcertainly not an expert at this,
but their comment abouthypotension or low blood
pressure causing this there'ssomething there.
There's a lot of good sciencebehind that.
(03:00):
These medications Ozempic,monjaro, zepbam, wegovi, all of
them can cause a decrease inyour blood pressure.
They can cause it eitherdirectly or through weight loss.
Just entering this weight lossphase can bring your blood
pressure down.
We see this after bariatricsurgery.
If someone's on three bloodpressure medications and I do
(03:21):
bariatric surgery before they'veeven lost a pound, I stop at
least one of those medications,sometimes two, because I know
their blood pressure is going todrop very rapidly in those
first few weeks after surgery,because that weight loss phase,
the act of losing weight, iswhat causes the blood pressure
to drop.
And so we're putting patientson these GLP-1 meds and maybe
(03:44):
not adjusting their high bloodpressure meds, and so the blood
pressure is dropping.
And again, I'm not anophthalmologist.
I think this is a very goodpoint.
If this is what's causing theION, I could believe it.
But again, I would certainlyleave this up to someone who
studies this disease on aregular basis, on a regular
(04:05):
basis.
But I think the point is verywell taken, which is that if you
are on one of these medicationsand you also take blood
pressure pills, that you shouldpay very close attention to your
blood pressure.
The classic symptom of beingoverdosed on your blood pressure
medicine is what's calledorthostatic hypotension, which
means you stand up and you feeldizzy or faint for a few seconds
and you can actually pass outfrom this and that can be quite
dangerous.
It's the fall, that's thedangerous part.
(04:26):
You're not going to faint andgo into cardiac arrest or
anything like that, it's justyou're going to fall and hit
yourself, hit your head orsomething.
If you are standing up andyou're starting to take one of
these medications, or you've hadbariatric surgery and you're
standing up and you're feelingdizzy or faint, that's certainly
something you should be callingand talking to your doctor
(04:47):
about and potentially holdingoff on your blood pressure
medication and adjusting thatrelatively quickly.
That's a very good point.
Great question.
Zoe (04:55):
Yeah, well, and also it leads me to think, you know,
hopefully there's more studiesthat might be a little bit more
robust to show potentially thecausation rather than the slight
correlation.
Dr. Weiner (05:07):
Yeah, this article came out probably two months ago
and there really hasn't been alot of uptake on it.
I don't see anybody kind oftalking too much about it.
There's not a lot of concernabout it.
Everybody kind of recognizeshey, that's kind of an
interesting point.
But we certainly would need alot more data before we would
change our prescribing habitsbecause of all the good things
(05:29):
that these medications can do.
So all right, sarah, what's ournext question?
Sierra (05:34):
Okay, next question comes from our podcast episode
how a Gastric Bypass Could Ruinyour Life.
This question is from Pearl.
What do you think aboutmocktails?
Zoe (05:46):
in your life.
This question is from Pearlwhat do you think about
mocktails?
Okay, I love this questionbecause I love making mocktails
and I love drinking them out offancy glasses.
That's the key is drinking themout of a wine glass or a fancy
glass because it makes it feelmore special.
But we have to be careful withmocktails, especially if you're
ordering them out at arestaurant, because they can be
very sugary, just like cocktails, right.
And so a couple of my favoritecombinations for mocktails take
(06:11):
sparkling water, right, like aLa Croix or whatever, and
pairing it with either muddledfruit or some sort of
fruit-based herbal tea.
And so a combination that I'vereally enjoyed is Target has
this really delicious hibiscusraspberry tea, and the key is
because it's so vibrant in color, it's gorgeous and it's
(06:33):
naturally sweet.
Putting a little bit of thatwith some sparkling water and
like a lime wedge or somethinglike that in a wine glass, and
you've got a perfect, refreshing, hydrating mocktail.
Yeah, something else that I've Ican't remember if I've talked
about this yet.
However, what I love to do thissummer was actually freeze
(06:55):
watermelon cubes, and thenthey're.
So here's what you do you sliceup your watermelon into cubes,
but you can't plop them all intoa bag and then freeze them,
because they'll all clumptogether and freeze together,
right?
So putting them on a cookiesheet first, individually freeze
them, because they'll all clumptogether and freeze together,
right?
So putting them on a cookiesheet first, individually freeze
them, and then, once they'refrozen, then you put them in the
gallon size Ziploc bag and takea couple out, put them in your
(07:19):
glass, pour some water orsparkling water over the top,
and not only does it keep thedrink cold, but that watermelon
juice starts to flavor the wateras well, and I found that
really nice yeah.
Dr. Weiner (07:32):
I think we've associated alcohol with
celebration and there's a lot ofpeople out there who are like
they have one drink, oh, I'lljust have it.
Yeah, no, I'll have a drink,I'm going to celebrate.
And the truth is that one drinkof alcohol probably does very,
very little to kind of causethem to feel drunk and really
doesn't change the way they feelvery much.
(07:55):
It's just not a ton of alcohol,but yet they all have a drink,
because that's what you do whenyou celebrate.
But it really is that act ofhaving that kind of special
drink.
You know, with that watermelonice cube or the lime wedge on
the side of the glass or thefancy glass or the fancy ice
cubes, you can buy the squareblock or the special molds.
(08:15):
And I think that's a reallyinteresting point is that
there's other ways to kind ofmake a drink special Elevate,
elevate, I love that word.
There's other ways to elevate adrink besides adding alcohol.
Zoe (08:27):
Absolutely, and also this is something that I talk with
people about all the time Ifthey're really struggling to get
their hydration in or theydon't like water by itself is
how can we jazz it up, make it alittle bit more exciting, make
it a little bit more special?
And so definitely love thedifferent cocktail varieties or,
I'm sorry, mocktail varieties.
Dr. Weiner (08:46):
Yes, I would share your, your passion for hibiscus,
tea.
It really is delicious.
Yeah, it's is delicious.
Yeah, it's kind of that perfectherbal, fresh, little citrus.
Absolutely All right, sierra.
How about our next question?
Sierra (09:00):
Next question was on our YouTube video, small Weight
Loss After Sleeve, bella Donnaasks I had my surgery almost two
years ago and it almostliterally did nothing.
I lost 15 pounds on my own withthe liquid diet and only 20
(09:20):
pounds after surgery.
I have a lot of friends andfamily that have had the same
surgery and were at least twicemy size and are all now very
thin.
But I had a very differentexperience.
First off, I was in a lot ofpain after surgery and I had
been told by almost everyone.
First off, I was in a lot ofpain after surgery and I had
been told by almost everyonethat they didn't have any pain
afterwards, except for the firstcouple of days.
I experienced no nausea orvomiting, no change to my
(09:41):
appetite or cravings, noproblems with food going down.
It just went a little slowerthe first couple weeks Nothing.
The only thing that happenedwas I had to have my gallbladder
removed shortly after mysurgery.
Literally nothing changed.
I even went in for a follow-upand if it weren't for the pain I
felt after surgery and thescars, I would have thought that
(10:01):
they never did the surgery.
Dr. Weiner (10:04):
So this is complicated.
So I think, first of all, a lotof people look at that pre-op
weight loss on the fasting dietand they discount it like, oh,
the surgery didn't do that, Idid that before surgery.
But the truth is they did itthrough a very low calorie diet.
That's what the pre-op diet is,and we know that.
What happens if you go on avery low calorie diet, what
(10:26):
happens afterward?
You lose a lot of weight.
You lose a lot of weight andthen, if you don't have surgery
or do anything else, you gain itall back right.
So that way, even though youlook at it and say, oh, I'd lost
it before the sleeve, you wouldhave gained it all back.
So if you still have maintainedthat weight loss that's I that
weight loss belongs to thesleeve it all's bundled up
(10:46):
together exactly so.
So this person lost 15 poundsbefore and then lost about 20
pounds after sleep 35 pounds.
We don't know what theirstarting weight is.
That's certainly.
I don't think.
There's not really anybodygoing into the surgery saying I
want to lose 35 pounds, right?
Most people have 50, 60, 70pounds and that's what they're
hoping for.
We've talked about this overand over again.
(11:07):
With the sleeve, there's a lotof variability.
There are some people who don'tlose a ton of weight and there
are other people who lose crazyweight, and that's one of the
things that I find sometimesfrustrating.
The advent of GLP-1s has addedthat extra buffer where we can
add the GLP-1 in and now we cantake that kind of modest weight
(11:28):
loss and augment it.
But to me, this is a patientwho is not very happy with their
results, and I get it.
They didn't lose as much asthey wanted.
But that's why the pre-opeducation is important and also
why the post-op care isimportant, like the meeting with
(11:49):
the dietician on a regularbasis to make sure the nutrition
is optimized, staying involvedin your bariatric program.
If there's an option forgetting you started on GLP-1s,
you take that option.
This is a lifelong struggle.
This is not a one and donetreatment, and so the idea that
you're just going to have asleeve and then go on with your
(12:11):
life and lose tons of weight, itmight happen.
It also might not, and there'slots and lots of people out
there on both sides of thatequation.
Lots of people have been supersuccessful and super happy with
their sleeve, lots of people whoare not so happy with their
sleeve, and that's what I thinkseparates the you know, an
average bariatric program from agreat one.
(12:33):
A great bariatric program isgoing to have in place for you
the dietician support, the GLP-1medications, all of the other
things.
You need to take that halfthose patients who don't have a
great result from their sleeveand help them get that good
result.
Amplify it up as much aspossible.
What are you going to do withthis patient if they're in your
nutrition group?
Zoe (12:52):
So, of course, we would want to make sure that we're
optimizing their nutrition.
Are we really taking fulladvantage of the tool?
Because the sleeve is still atool, whether they lost 20
pounds, 35 pounds after or not,it's still a powerful tool that,
when combined with thelifestyle modifications, we can
(13:14):
potentially amplify it further.
Right?
So I would see, did it say howlong, um, how long ago they had
their, their sleeve?
I?
Dr. Weiner (13:22):
don't know if they specify that.
Zoe (13:24):
So, depending on how long after those hunger cues coming
back, maybe the volume of foodtolerated is increasing again.
This patient could potentiallyreally benefit from doing the
metabolic reset diet or, like Iwas talking with somebody on a
one-on-one today, a modifiedmetabolic reset diet.
She had a sleeve about a yearand a half ago and we were
(13:47):
talking through how to modifythe metabolic reset diet so that
she could still follow theprinciples but maybe not push
the volume quite as high.
So that would be something Iwould also really want to be
interested in.
How can we tweak the movement?
Do those movement sprinklesReally?
Just digging into all of thoseother lifestyle factors that can
(14:08):
, like I said, amplify theeffects of the tool?
Dr. Weiner (14:11):
Right, yeah, and I think that's this to me.
This, this comment, reallyshows that it's not just having
the surgery and then getting theresult.
Zoe (14:20):
Not the easy way out.
It's not the quick fix, yeah.
Dr. Weiner (14:23):
This is part of a comprehensive plan and to me, I
think that's what's missing isthat we haven't put that
comprehensive plan in place.
There's some people out therewho kind of get lucky and it
just all falls into place andit's a one and done surgery.
We see that certainly more witha gastric bypass than a sleeve,
but we see it with a sleeve too.
I think this person is alsocomparing themselves to other
(14:45):
people and that generally isn'tgoing to help much.
Yeah, your journey is yourjourney.
Recipe for frustration, yeah,and so I think you have to, kind
of, instead of looking at whatother people's experience has
been and saying, why didn't Iget that same experience, you
have to look at what yourexperience is and see how you
can make your life better.
Yeah, because that's your onlyrealistic option right now.
Right.
Zoe (15:03):
Yeah, you can't control the outcomes of other people, but
you know, even if theirbariatric center didn't, doesn't
have the nutritional support.
Of course, our nutritionprogram is open to anyone in the
country, so if you're in asimilar situation and you're
struggling post-op, um, or youknow you're on a GLP-1 or
(15:24):
whatever, I would be happy tohave you in our online Zooms and
really amplifying that toolthrough your nutrition changes.
Dr. Weiner (15:32):
And we do have a platinum program.
So we'll see people from allover the country through our
platinum program and I'll meetwith them and we'll try to
figure out what happened andwhat we can do to rescue it.
And a lot of times we can getpeople back on track and get
them the weight loss that they'dhoped for originally.
It might not be as easy as theythought it was going to be, but
it's possible.
Zoe (15:53):
It's a good option to explore.
Dr. Weiner (15:54):
All right.
What's our last question,Sierra?
Sierra (15:57):
Okay.
Last one is from our YouTube,episode 38, a Dose of Dilemma.
Nicole Chip asks I started thePound of Cure diet six months
before my gastric bypass.
Eating a pound or more ofveggies was no problem back then
.
In the first few months aftersurgery, I understood that my
nutrition priorities would bedifferent for a while, as I
(16:19):
recovered and focused on proteinand figuring out which foods I
could tolerate.
But now, at six months out, myappetite is starting to return a
little bit, and so I know I'mnearing the stage you speak
about of moving away fromprotein first to produce first.
But so many bariatric resourceseither assume you are in the
first six weeks or that you areseveral years out from surgery
(16:41):
and battling regain.
I would love to hear youradvice for navigating the murky
middle when you're still losingweight, but at a slower pace,
and it's not quite the earlyhoneymoon phase anymore, but not
quite the new normal either.
How do we get from point A topoint Z with as few bumps in the
road as possible?
Dr. Weiner (16:59):
Zoe, what do you think about the murky middle?
Zoe (17:02):
I think the murky middle can be murky but it's also can
be a really great opportunity.
Yeah, to almost like practicefor maintenance.
Right, because maybe that murkymiddle is when they can start
eating a bit more.
Their hunger maybe starts tocome back and it's like, okay,
I've been trained or instilledto prioritize protein and that
(17:26):
might feel like a littlelackluster at this time, right,
and so as I like to describe it?
Sure, yes, we still want toprioritize protein, but ideally
through whole food protein andweaning off of those protein
shakes so much.
But the key is really adding inthat extra volume and filling
in the gaps.
I always like to say fill inthe gaps, anything else that you
(17:49):
can eat, with vegetables, withfruit, so that you are still
helping with your weight loss,but you're getting that fiber,
you're getting that volume, soyou feel full and satisfied and
kind of helping that yourselfthrough that honeymoon period a
bit more, maybe pushing througha plateau or getting that last
(18:10):
bit of weight loss during yourmurky middle honeymoon period,
but utilizing that time.
It's not that we want to goback and reset the pouch, go
back to only shakes.
That's always going to backfire, from my experience.
Dr. Weiner (18:23):
Yeah, no, I agree with you.
I think the way you put it isexactly right.
In those first few months it'slike I can barely get in enough.
I just got to get in what I canget in so I can survive.
And you're worried about yournutritional state and your
health.
And with being conscientiousand thoughtful, we get everybody
through it and it tends to befairly comfortable, but it is
(18:43):
some work.
But then all of a sudden youget into what we call the murky
middle A lot of people call itthe honeymoon phase and you can
suddenly eat a little bit more.
And you're right, what you do?
You put in the vegetables andyou can eat a little bit more
after that more vegetables, morefruit, more nuts and seeds,
beans, and so it's going to be agradual process and understand
(19:05):
that that's the journey.
Zoe (19:07):
And that's where also it can fall.
People can fall into theportion control trap.
Dr. Weiner (19:12):
Absolutely.
Zoe (19:13):
You know that murky middle can be a dangerous slippery
slope, right If you're notviewing it from the lens of.
This is my opportunity tocapitalize on the honeymoon
period with my tool and toinstill these eating habits that
(19:35):
I know are going to help memaintain the weight loss longer
term.
But that portion control trapoof, that is a dangerous one.
Talk a little bit more aboutthe portion control trap.
So the portion control trap issomething that I see some people
struggle with.
Dr. Weiner (19:46):
It's out there for sure.
Zoe (19:48):
Especially, I'd say, people who maybe come to us in the
platinum program experiencingsome weight regain after their
sleeve let's say likely due tofalling into that portion
control trap, which is utilizingthe portion control aspect, the
volume restriction aspect ofthe surgery, to just eat less
(20:12):
and not change how they'reeating.
So it might be, oh, I'm justgoing to have half of the slice
of pizza and then that turnsinto a slice and then you know
pretty soon eating the sameamount as before.
But what's really dangerousabout it is because, especially
during that honeymoon period,when your hormones are working
with you as well as the portioncontrol aspect, you're getting
(20:35):
that positive reinforcement fornegative behavior.
Dr. Weiner (20:39):
No consequences to eating poorly in the murky
middle Right there will be downthe road, exactly yeah.
Zoe (20:44):
And you know it's a whole heck of a lot easier to make
lasting changes to your habitswhen you're feeling successful
and you are experiencingprogress than it is to wait
until you're at your weight andyou're in maintenance to then
okay, now I'm once, I lose allmy weight, then I'm going to
change my eating habits.
Well, you're not gettingpositive reinforcement from
(21:05):
seeing you know those changes asmuch in your body.
So it's something we definitelywant to look out for and nip in
the bud if you find yourselfkind of falling down that trap.
Dr. Weiner (21:14):
Yeah, we know that at three months, you can't eat
nearly as much as you're goingto be able to in a year, and at
two years it's going to be evenmore.
We know there's going to bethis progression.
You will be able to eat moreand more and more as you move
through the murky middle, and sothe question is what are you
going to fill it with?
Because you are going to fillit, you're going to eat more,
(21:36):
and are you going to fill itwith a bigger piece of pizza, or
are you going to fill it withmore fruits, veggies, nuts,
seeds and beans?
Zoe (21:47):
If you watching this podcast, I think you know the
answer to that one and the other.
The last little note I wantedto say on that is don't expect
yourself or force yourself toeat that same small amount that
you were eating at three monthsout.
When you're a year out I talkto people about that too it's
like, oh well, I was only eatingthis small amount, I should be
eating that same amount.
And I was like, well, no,because if you're depriving your
(22:08):
body of what it of, that, thatfuel, and you're just kind of
ignoring that hunger, it's goingto catch up, it's going to
backfire, and then that, could,you know, lead to going down the
wrong path.
Dr. Weiner (22:22):
Yeah, all right.
Well, thank you for watching orlistening.
We're on social media TikTok,instagram, youtube.
A pound of cure, a pound ofcure, and please reach out to us
, drop us questions for our nextQ&A session.
We'd love to hear from youwhether things are going well
for you, whether you'restruggling.
(22:42):
Tell us how you're doing.
Zoe (22:44):
Yeah.
Dr. Weiner (22:45):
See you next time.
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